Purpose: One of the treatment methods for critical limb ischemia is percutaneous transluminal angioplasty (PTA). In severe cases, however, multiple vessels are blocked, including the main vessels of the lower extremities. This study aimed to determine whether wound healing and symptom relief occurred depending on whether the communicating artery was patent after PTA.Methods: In total, 120 patients (120 lower extremities) who underwent PTA from January 2016 to February 2018 were followed up for 6 months.Results: Out of 87 patients who had wounds, 34 had a patent communicating artery and 53 had a non-patent communicating artery. Out of 34 patients who had wounds but a patent communicating artery, 29 completely healed within 6 months. Among the 53 patients who had wounds and a non-patent communicating artery, 16 totally healed within 6 months, and 37 did not heal within 6 months. In the indirect revascularization group, 18 of 21 patients with complete wound healing within 6 months in the indirect revascularization group had a patent communicating artery.Conclusion: If only indirect revascularization is possible, it is important to ensure the patency of the communicating vessels that link the pedal and plantar arterial systems.
The authors observed good clinical courses in patients with lower limb ulcers and extensive skin inflammation who showed early venous enhancement at contrast-enhanced lower extremity computed tomographic angiography. The author hypothesized that these early venous enhancements tend to occur in conditions of healthier vascular status. A total of 145 patients who met the inclusion criteria were classified based on the degree of arterial occlusion and early venous enhancement according to lower extremity angiography. Early venous enhancement correlated with age over 65 (t-score = 0.001), absence of ulcer history (t-score = 0.003), absence of amputation history (t-score = 0.004), and low ankle-brachial index (
P
value = .001). We confirmed that the factors related with early venous enhancement differ from the factor inducing arterial occlusion. Prior to this study, early enhancement of veins in the lower limb was thought to be an artifact. However, in this study, veins that show early enhancement are suspected of being healthier and more responsive to inflammation than those that do not show early enhancement. These findings may help to predict the clinical course and to determine therapeutic planning without additional studies. Also, it can be easily reproduced in other facilities.
Background: Frontal sinus fractures are relatively rare. Their surgical management significantly differs depending on whether the posterior wall is invaded and the clinical features vary. A bicoronal incision or endoscopic approach can be used. However, the minimally invasive approach has been attracting attention, leading us to introduce a simple and effective surgical method using multiple-threaded Kirschner wires.Methods: All patients had isolated anterior wall fractures without nasofrontal duct impairment. The depth from the skin to the posterior wall was measured using computed tomography to prevent injury. The edge of the bone segment on the skin was marked, a threaded Kirschner wire was inserted into the center of the bone segment, and multiple Kirschner wires were gently reduced simultaneously.Results: Surgery was performed on 11 patients. Among them, seven patients required additional support for appropriate fracture reduction. Therefore, a periosteal elevator was used as an adjunct through a small sub-brow incision because the reduction was incomplete with the Kirschner wire alone. The reduction results were confirmed using facial bone computed tomography 1 to 3 days postoperatively. The follow-up period was 3 to 12 months.Conclusion: The patients had no complications and were satisfied with the surgical results. Here we demonstrated an easy and successful procedure to reduce a pure anterior wall frontal sinus fracture via non-invasive threaded Kirschner wire reduction.
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